Disease In Elderly People Research Articles

Blood pressure falls with disease in elderly people

Blood pressure falls with disease in elderly people

Is cardiothoracic ratio in healthy middle aged men an independent predictor of coronary heart disease mortality? Whitehall study 25 year follow up

Aetiological studies of myocardial ischaemia have tended to concentrate on factors which influence atherothrombotic processes in the coronary arteries rather than myocardial pathophysiology.1 The commonest clinical measure of heart size—cardiothoracic...

Eye disease in elderly people

The majority of patients seen in ophthalmic clinics are over the age of 60. In addition, ophthalmology is a major care provider for elderly people. In the author’s unit a recent review of patients undergoing surgery showed that 75% of them were over the age of 60 and 38% over 75. Ten years ago these proportions were 50% and 25% respectively. Much of this reflects the increasing demand for and success of cataract surgery. Age-related macular degeneration is the major cause of visual loss in the United Kingdom and elsewhere and is responsible for 48.5% of all patients registered blind or partially sighted in England and Wales.

4.P.381 Apolipoprotein E polymorphism, dyslipidemia and Alzheimer disease in elderly people in Chile

4.P.381 Apolipoprotein E polymorphism, dyslipidemia and Alzheimer disease in elderly people in Chile

Analysis Of The Impact Of Fuel ConsumptionOn Mortality Rates In Sao Paulo

The paper examines the impact of fuel type on air pollution and thereby on human health. It presents the results of a time series analysis relating the consumption of ethanol and fossil fuels and measures of air pollution with respiratory and cardiovascular mortality in elderly people in Sao Paulo for the period January 1991 to December 1994. The results of a linear regression analysis show a significant association between air pollution and mortality due to respiratory diseases; PM,o presented the highest association among the pollutants. Although the different temporal basis of the data on fuel consumption did not enable a direct association with daily mortality to be established, the results suggest that there is an indirect relationship between higher levels of ethanol and lower levels of both PMio concentrations and mortality from respiratory diseases in elderly people. Transactions on the Built Environment vol 30, © 1997 WIT Press, www.witpress.com, ISSN 1743-3509 436 Urban Transport and the Environment for the 21st Century

Effect of Strenuous Exercise on Fibrinogen and Fibrinolysis in Healthy Elderly Men and Women

The elevated incidence of thrombotic disease in elderly people may be associated with an increase in PAI-1 and fibrinogen with ageing. Cross-sectional studies report an inverse relation of PAI-1 and fibrinogen with physical activity, but training studies show inconsistent results. In a controlled intervention study among elderly subjects (aged 60-80 years) we observed a moderate decrease in PAI-1 antigen (4%, -2.1 +/- 2.4 ng/ml), a significant increase in t-PA activity (11%, 0.07 +/- 0.04 IU/ml) and an unexpected significant increase in fibrinogen (6%, 0.18 +/- 0.07 g/l) in subjects following a 6-month intensive training program as compared to controls. Reduction in PAI-1 antigen was significantly associated with a decrease in triglycerides (beta = 10.3 ng/ml per 1 mM, p <0.01) and insulin (beta = 2.37 ng/ml per 1 mU/l, p = 0.07). Increase in fibrinogen coincided with a rise in C-reactive protein (p <0.001). These data suggest that regular intensive activity may increase fibrinolytic activity in a moderate way, but also may cause chronically elevated plasma levels of acute phase proteins in elderly persons.

Lipoprotein(a) as a risk factor for cardiovascular disease in elderly patients with diabetes

Lipoprotein(a) (Lp(a)) is an independent risk factor for cardiovascular diseases in non-diabetic people, but few studies have been done in diabetic patients. To investigate whether Lp(a) is a risk factor for cardiovascular disease in elderly people with diabetes, we examined the association of Lp(a) and serum lipid levels (total cholesterol: TC; triglycerides: TG; and high-density lipoprotein cholesterol: HDL-c) with the incidence of coronary artery disease and cerebrovascular disease. We studied 354 outpatients(131 men and 223 women, 60-97 years of age) with non-insulin-dependent diabetes mellitus. The mean concentration of Lp(a) was 21.1 +/- 19.6 mg/dl and the median was 14.0 mg/dl. The Lp(a) concentration did not correlate significantly with age or with sex, but it did correlate significantly with TC (r = 0.152, p < 0.05) and with the level of apoprotein B (r = 0.168, p < 0.05). The incidence of cerebrovascular disease was significantly higher in patients with high concentrations of Lp(a) (> or = 30 mg/ dl) than in those with low concentrations (< 30 mg/ dl). Multivariate logistic regression analysis revealed that male sex, hypertension, a high level of HbA1c, a low level of HDL, and a high level of Lp(a) were independent risk factors for cerebrovascular disease. The incidence of coronary artery disease tended to the higher in those with high concentrations of Lp(a) (> or = 30 mg/dl). However, multivariate logistic regression analysis revealed no significant correlation between Lp(a) concentration and the incidence of coronary artery disease. We conclude that a high concentration of Lp(a) is an independent risk factor for cerebrovascular disease in elderly patients with diabetes.

Cleaning up Clostridium difficile infection

Clostridium difficile infection affects mainly the elderly, among whom reported cases increased almost eight-fold between 1990 and 1994 in England and Wales. Here C difficile was the most commonly reported cause of intestinal infection in the elderly in 1994, ahead of both salmonella and campylobacter (figure). 1 Djuretic T Ryan MJ Fleming DM Wall PG Infectious intestinal disease in elderly people. Commun Dis Rep CDR Rev. 1996; 6: R107-R112 PubMed Google Scholar Elderly individuals may have impaired resistance to colonisation by C difficile, 2 Borriello SP Barclay FE An in-vitro model of colonisation resistance to Clostridium difficile infection. J Med Microbiol. 1986; 21: 299-309 Crossref PubMed Scopus (89) Google Scholar which in turn can lead to symptomless carriage, diarrhoea, or colitis (with or without pseudomembrane formation). C difficile is the commonest infective cause of hospital-acquired diarrhoea, but the true incidence of community-acquired C difficile infection is unknown because many laboratories do not routinely look for the bacterium or its toxin(s) in faecal specimens from general practice.

Epidemiology and Prevention of Cardiovascular Diseases in Elderly People

Epidemiology and Prevention of Cardiovascular Diseases in Elderly People

Projecting Disease When Death Is Likely

Projection disease incidence, prevalence, and net morbidity is often needed when individuals are likely to die, either disease free or after the disease has developed. Examples of this include remission of cancer or heart disease in elderly people who can die from these or other causes and occurrence of a particular acquired immune deficiency syndrome illness in human immunodeficiency virus type 1 (HIV-1) disease. Death is not an ancillary event but, rather, indicates either and end to disease morbidity or an end to risk to ever develop the disease. Thus, time to disease survival analyses that censor disease-free individuals at death can produce misleading results. The paper describes several useful quantifications of disease and death for this setting. A paradigm that utilizes Kaplan-Meier functions to estimate these quantities is introduced. The approach anchors on a four-stage disease/death model: stage A, living without disease; stage B, dead without ever developing disease; stage C, developed the disease and living; and stage D, dead after developing the disease. An application is made to projecting cytomegalovirus disease in a cohort of HIV-1-infected users of zidovudine and Pneumocystis prophylaxis from the Multicenter AIDS Cohort Study (MACS) during 1989-1993. At 3 years after a CD4+ count below 100/microliters, a man had an 18.7%, 46.3%, 5.3% or 29.9% chance, respectively, to be in stage A, B, C, or D. This man, on average, had 0.28 years of cytomegalovirus morbidity during these 3 years.

Detection of human papillomavirus in extragenital Bowen's disease using in situ hybridization and polymerase chain reaction.

Extragenital Bowen's disease (EBD) has rarely been studied for the presence of human papillomaviruses (HPVs). Twenty consecutive patients with EBD were investigated for the presence of HPVs using in situ hybridization with a generic probe that can detect HPV DNA types 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52 and specific probes for HPV DNA types 6/11, 16/18, and 31/33/35. All cases were tested with the polymerase chain reaction (PCR) technique employing the L1 consensus primer pair, MY11 (primer for the positive strand) and MY9 (primer for the negative strand) complementary to genital and dermal HPV types. Seven caucasian patients, five males and two females, with an average age of 70.4 years, showed positive in situ hybridization (ISH) for HPV DNA. The positivity varied from 5 to 40% of neoplastic cells. Three of seven of the ISH DNA-positive cases showed a positive PCR for DNA HPVs. The role of HPVs in human tumors is not fully understood since oncogenic types of HPVs have been found in normal tissue and the actions of cofactors have been postulated. Bowen's disease usually occurs in elderly people in whom the efficiency of the immune systems may be compromised. The association between HPV infection and low efficiency of the immune response may be responsible for HPV-related Bowen's disease in elderly people.

Cardiovascular disease in elderly people: A neglected and growing threat

Cardiovascular disease in elderly people: A neglected and growing threat

Late-onset Huntington's disease: a clinical and molecular study.

Using the Huntington's disease register for South Wales, a total of 86 affected individuals were identified living in the counties of Mid Glamorgan, South Glamorgan and Gwent, giving a point prevalence rate for Huntington's Disease in South East Wales of 6.2/100,000. Only four (4.7%) of these individuals developed their symptoms after the age of 60 years. A subsequent retrospective search of the register identified a total of 33 individuals with clinical evidence of Huntington's disease and whose age of onset of symptoms occurred between the ages of 60 and 77 years. In this group the median time for disease duration from the onset of symptoms was 13 years (range 0.5-25 years), with survival up to age 86 years recorded. Initial symptoms of Huntington's disease included disturbance of gait in 32 individuals; 31 had involuntary movements, and 20 had abnormality of speech. Major psychiatric symptoms were present in only six cases; but approximately a third (ten cases) had symptoms related to impaired cognitive function. Molecular analysis was possible on ten individuals in the series. The expanded CAG repeat sequence in the Huntington's disease gene was found in all cases, with a narrow range of 36-38 repeats, representing the smallest repeats seen in our Huntington's disease group. Our study suggests that Huntington's disease in elderly people causes predominantly motor disturbance at onset with relatively mild disability and a favourable outlook for both independent living and for life expectancy. However, the potential for under-diagnosis in this age group may have considerable genetic consequences, with transmission of the disorder to numerous descendants by the time its hereditary nature is recognized.

Changes in gastrointestinal function attributed to aging

There are numerous reports in the literature of impaired gastrointestinal function with aging. However, most gastrointestinal functions remain relatively intact because of the large reserve capacity of the intestine, pancreas, and liver. Clinically important changes in gastrointestinal function with aging in human include decreased taste thresholds, hypochlorhydria due to atrophic gastritis, and decreased liver blood flow and size. Increased absorbability of lipids and large size molecules has been demonstrated in aging animals, but this has not been studied in humans. Nutrients with impaired gastrointestinal bioavailability in aging include dietary B-12, calcium carbonate, and ferric iron in atrophic gastritis; calcium, zinc, and possibly carbohydrate in a mixed meal. The implications of these changes for health maintenance and chronic disease in elderly people are in need of study.

Visual problems in the elderly population and implications for services.

To determine the prevalence of visual disability and common eye disease among elderly people in inner London. Cross sectional random sample survey. Inner London health centre. Random sample of people aged 65 and over taken from practice's computerised age-sex register. Presenting binocular Snellen 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence of blindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care. 207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3.9% by American criteria. The prevalence of low vision (WHO criteria) was 7.7%. The prevalence of visual impairment (American criteria) was 10.6%. Cataract accounted for 75% of cases of low vision. Only eight out of 16 patients with low vision were known by their general practitioner to have an eye problem. 56 subjects (27%) would probably have benefited from refraction. Comparisons with studies in the United States and Finland suggested higher rates in this sample, mainly due to the prevalence of disabling cataract. There seems to be a considerable amount of undetected ocular disease in elderly people in the community.

Legionnaires' Disease in Elderly People: The First Sign of an Outbreak in the Community?

Legionella pneumophila is responsible for up to 5% of cases of community-acquired pneumonia and mainly affects people aged over 50 years. The confirmation of legionellosis in two elderly patients living close to each other prompted a search for other cases. A total of eleven subjects with legionnaires' disease was recognized. The clinical findings are described and the diagnosis of legionellosis is discussed. Environmental investigations pointed to a cooling tower in the local town centre as the probable source of infection.

Pulmonary function in gastro-oesophageal reflux disease of elderly people.

An effect of gastro-oesophageal reflux disease (GORD) on respiratory function was studied in elderly patients. Twenty-seven patients with, and 29 patients without, abnormal gastro-oesophageal reflux (GOR) in 24-hour pH monitoring were included in the study. Symptoms suggestive of gastrooesophageal reflux disease were recorded and spirometry was performed in all the patients. Patients with abnormal GOR had lower vital capacity (percentage of predicted value) (VC%) than those with normal pH monitoring result (92 vs 102, p = 0.032). Forced vital capacity (FVC%) and forced expiratory volume in one second (FEV1%) did not differ between these two groups. Thirty-two per cent of patients with slight and 73% of patients with moderate or severe reflux in pH monitoring had abnormal VC%, FVC%, or FEV1% (less than 80% of predicted value) at spirometry (vs 30% of patients without reflux, p = 0.039). When patients were divided according to their symptoms suggestive of GORD, lower VC%, FVC%, and FEV1% were found in patients with than in those without symptoms (87 vs 102, p = 0.0018; 76 vs 91, p = 0.0099; 80 vs 93, p = 0.0026). In conclusion, mainly a restrictive ventilatory defect was associated with GORD in elderly patients.

Does plasma cholesterol concentration predict mortality from coronary heart disease in elderly people? 18 year follow up in Whitehall study.

To explore the extent to which the relation between plasma cholesterol concentration and risk of death from coronary heart disease in men persists into old age. 18 year follow up of male Whitehall civil servants. Plasma cholesterol concentrations and other risk factors were determined at first examination in 1967-9 when they were aged 40-69. Death of men up to 31 January 1987 was recorded. 18,296 male civil servants, 4155 of whom died during follow up. Cause and age of death. Cholesterol concentration in 1967-9 and number of years elapsed between testing and death. 1676 men died of coronary heart disease. The mean cholesterol concentration in these men was 0.32 mmol/l higher than that in all other men (95% confidence interval 0.26 to 0.37 mmol/l). This difference in cholesterol concentrations fell 0.15 mmol/l with every 10 years' increase in age at screening. The risk of raised cholesterol concentration fell with age at death. Compared with other men cholesterol concentration in those who died of coronary heart disease was 0.44 mmol/l higher in those who died aged less than 60 and 0.26 mmol/l higher in those aged 60-79 (p = 0.03). For a given age at death the longer the gap between cholesterol measurement and death the more predictive the cholesterol concentration, both for coronary heart disease and all cause mortality (trend test p = 0.06 and 0.03 respectively). Reducing plasma cholesterol concentrations in middle age may influence the risk of death from coronary heart disease in old age.

Diagnostic Procedures in Psychogeriatric Medicine

Interest in the health and diseases of elderly people has been growing in most parts of the world during the last few decades. One reason is that knowledge of normal aging and of the manifestations of disease in the higher age groups has been incomplete compared to the corresponding knowledge regarding other periods of human life. Another reason is the increasing absolute and relative number of elderly not only in the developed, but also importantly in the developing world. It is estimated, for example, that the increase of the population aged 80 and over from 1980 to 2020 will amount to 108% in the developed world compared to 377% in the developing world (U.N. Department of International Economic and Social Affairs, 1985).

A Population Survey of Cardiovascular Disease in Elderly People: Design, Methods and Prevalence Results

A cross-sectional survey of an age- and sex-stratified random sample of the elderly population living in Southampton was undertaken with the object of measuring the frequency of cardiovascular disease by questionnaire and examination, and assessing cardiac anatomy and physiological function by noninvasive methods. The response rate was 64% and 259 men and women aged between 65 and 95 years were interviewed and examined and had a twelve-lead ECG and chest radiograph. Forty per cent of men and 47% of women reported a diagnosis of one or more cardiovascular diseases, of which high blood pressure 33%, coronary heart disease 14% (angina pectoris 11% and myocardial infarction 8%), peripheral arterial disease of the lower limbs 7%, and cerebrovascular disease 6% occurred most frequently. With the exception of high blood pressure, which women reported more frequently than men (40% vs 27%), the prevalence of these diagnoses by sex was similar. The self-administered WHO questionnaires gave point prevalence estimates for angina pectoris of 13%, possible myocardial infarction 7% and intermittent claudication 5%, which were similar to reported prevalences of these diseases, although disagreement in the classification of individuals for each disease was common. When comparing the WHO chest pain questionnaire with the doctors' independent diagnosis of angina pectoris in this population, the sensitivity of the WHO questionnaire was 79%, with a specificity of 98% and a predictive value of 88%. For each sex the sensitivity of the WHO chest pain questionnaire was similar but specificity and predictive value were both lower for women.(ABSTRACT TRUNCATED AT 250 WORDS)